Individual
MR. BROC CODI WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-1920
Mailing address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-1920
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10524A
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2013
Last updated
06/13/2016
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